Stroke Treatment From Onset To Rehabilitation
Volume 3 Issue 1 , pages 20-29
Published July 2017
Clinical Director, Department of Neurosciences, Hospital Germans Trias I Pujol, Universitat Autònoma de Barcelona, Spain
Institute of Interventional Diagnostic Neuroradiology, University Hospital, Inselspital, Bern, Switzerlan
Head of Neurology, Head of Stroke Center, Cantonal Hospital Aarau AG, Switzerland
Abteilung für Neurologie Landeskrankenhaus Hochzirl, Zirl, Austria and Research Unit for Neurorehabilitation South Tyrol, Bolzano, Italy
Corresponding Author: Antonio Dávalos – firstname.lastname@example.org
This symposium acknowledged considerable variation across European in-hospital stroke services in their level of expertise, facilities available for rapid neuroimaging, and access to treatment interventions for acute stroke patients. Stroke neurologists face the dilemma of deciding whether to dispatch acute stroke patients to a highly specialised comprehensive stroke centre, or to the nearest available centre.In Catalonia, all stroke centres are connected by telemedicine networks, and emergency services have received training in the Rapid Arterial Occlusion Evaluation (RACE) scale that predicts large vessel occlusion (LVO).These initiatives were precursors to the ongoing tRAnsfer to the Closest local stroke centre vs. direct transfer to Endovascular stroke Centre of Acute stroke patients with suspected LVO in the Catalan Territory (RACECAT) trial. This study is expected to provide evidence-based guidance for the most appropriate hospitalization of acute stroke patents. The relative contributions of intravenous thrombolysis (IVT) and mechanical thrombectomy (MT), as single or combined treatment interventions, in acute stroke patients, have not been fully elucidated. The rationale for the SWIFT DIRECT study is presented. This will investigate IVT as a bridging concept plus MT, versus direct MT. Strong evidence demonstrating continuous cardiac monitoring with insertable cardiac monitors (ICMs) is superior to standard monitoring for the detection of AF is presented. Current guidance for short-term standard monitoring may lead to substantial numbers of patients with AF remaining undiagnosed. The use of the Reveal LINQTMICM and the FocusOnMTM service provided by Medtronic is described. Finally, the role and clinical investigation of intrathecal baclofen for the treatment of post-stroke spasticity is discussed.
Key words: acute stroke, IVT, mechanical thrombectomy, RACECAT, SWIFT DIRECT, insertable cardiac monitors, intrathecal baclofen.
Acknowledgements: The editorial assistance of Mr Rob Goodwin, Oruen Ltd, in the preparation of this article is acknowledged with thanks.